TY - JOUR
T1 - A Systematic Review of Focal Cartilage Defect Treatments in Middle-Aged Versus Younger Patients
AU - Jeuken, R.M.
AU - van Hugten, P.P.W.
AU - Roth, A.K.
AU - Timur, U.T.
AU - Boymans, T.A.E.J.
AU - van Rhijn, L.W.
AU - Bugbee, W.D.
AU - Emans, P.J.
N1 - Funding Information:
This work was performed under the framework of Chemelot InSciTe, a private-public institute for biomaterial research and upscaling.
Publisher Copyright:
© The Author(s) 2021.
PY - 2021/10/1
Y1 - 2021/10/1
N2 - Background: Focal cartilage defects are often debilitating, possess limited potential for regeneration, are associated with increased risk of osteoarthritis, and are predictive for total knee arthroplasty. Cartilage repair studies typically focus on the outcome in younger patients, but a high proportion of treated patients are 40 to 60 years of age (ie, middle-aged). The reality of current clinical practice is that the ideal patient for cartilage repair is not the typical patient. Specific attention to cartilage repair outcomes in middle-aged patients is warranted. Purpose: To systematically review available literature on knee cartilage repair in middle-aged patients and include studies comparing results across different age groups. Study Design: Systematic review; Level of evidence, 4. Methods: A systematic search was performed in EMBASE, MEDLINE, and the Cochrane Library database. Articles were screened for relevance and appraised for quality. Results: A total of 21 articles (mean Coleman Methodology Score, 64 points) were included. Two out of 3 bone marrow stimulation (BMS) studies, including 1 using the microfracture technique, revealed inferior clinical outcomes in middle-aged patients in comparison with younger patients. Nine cell-based studies were included showing inconsistent comparisons of results across age groups for autologous chondrocyte implantation (ACI). Bone marrow aspirate concentrate showed age-independent results at up to 8 years of follow-up. A negative effect of middle age was reported in 1 study for both ACI and BMS. Four out of 5 studies on bone-based resurfacing therapies (allografting and focal knee resurfacing implants [FKRIs]) showed age-independent results up to 5 years. One study in only middle-aged patients reported better clinical outcomes for FKRIs when compared with biological repairs. Conclusion: Included studies were heterogeneous and had low methodological quality. BMS in middle-aged patients seems to only result in short-term improvements. More research is warranted to elucidate the ameliorating effects of cell-based therapies on the aging joint homeostasis. Bone-based therapies seem to be relatively insensitive to aging and may potentially result in effective joint preservation. Age subanalyses in cohort studies, randomized clinical trials, and international registries should generate more evidence for the large but underrepresented (in terms of cartilage repair) middle-aged population in the literature.
AB - Background: Focal cartilage defects are often debilitating, possess limited potential for regeneration, are associated with increased risk of osteoarthritis, and are predictive for total knee arthroplasty. Cartilage repair studies typically focus on the outcome in younger patients, but a high proportion of treated patients are 40 to 60 years of age (ie, middle-aged). The reality of current clinical practice is that the ideal patient for cartilage repair is not the typical patient. Specific attention to cartilage repair outcomes in middle-aged patients is warranted. Purpose: To systematically review available literature on knee cartilage repair in middle-aged patients and include studies comparing results across different age groups. Study Design: Systematic review; Level of evidence, 4. Methods: A systematic search was performed in EMBASE, MEDLINE, and the Cochrane Library database. Articles were screened for relevance and appraised for quality. Results: A total of 21 articles (mean Coleman Methodology Score, 64 points) were included. Two out of 3 bone marrow stimulation (BMS) studies, including 1 using the microfracture technique, revealed inferior clinical outcomes in middle-aged patients in comparison with younger patients. Nine cell-based studies were included showing inconsistent comparisons of results across age groups for autologous chondrocyte implantation (ACI). Bone marrow aspirate concentrate showed age-independent results at up to 8 years of follow-up. A negative effect of middle age was reported in 1 study for both ACI and BMS. Four out of 5 studies on bone-based resurfacing therapies (allografting and focal knee resurfacing implants [FKRIs]) showed age-independent results up to 5 years. One study in only middle-aged patients reported better clinical outcomes for FKRIs when compared with biological repairs. Conclusion: Included studies were heterogeneous and had low methodological quality. BMS in middle-aged patients seems to only result in short-term improvements. More research is warranted to elucidate the ameliorating effects of cell-based therapies on the aging joint homeostasis. Bone-based therapies seem to be relatively insensitive to aging and may potentially result in effective joint preservation. Age subanalyses in cohort studies, randomized clinical trials, and international registries should generate more evidence for the large but underrepresented (in terms of cartilage repair) middle-aged population in the literature.
KW - cartilage
KW - repair
KW - middle-aged
KW - bone marrow stimulation
KW - cell-based
KW - bone-based
KW - AUTOLOGOUS CHONDROCYTE IMPLANTATION
KW - OSTEOCHONDRAL ALLOGRAFT TRANSPLANTATION
KW - UNICOMPARTMENTAL KNEE ARTHROPLASTY
KW - REGENERATION PROGNOSTIC-FACTORS
KW - THICKNESS CHONDRAL DEFECTS
KW - MESENCHYMAL STEM-CELLS
KW - SURGICAL-MANAGEMENT
KW - SUBCHONDRAL BONE
KW - EARLY OSTEOARTHRITIS
KW - FOLLOW-UP
U2 - 10.1177/23259671211031244
DO - 10.1177/23259671211031244
M3 - (Systematic) Review article
C2 - 34676269
SN - 2325-9671
VL - 9
JO - Orthopaedic Journal of Sports Medicine
JF - Orthopaedic Journal of Sports Medicine
IS - 10
M1 - 23259671211031244
ER -